Even in an age of amazing ad-vances in medicine, few silver bullets exist in the fight against chronic health conditions. But studies show that women who daily take 400 micrograms of the B-vitamin folic acid (the amount found in most multivitamins) significantly reduce the chance that their unborn baby will develop a neural tube disorder such as spina bifida.

Folic acid may be the closest thing we have to a silver bullet for combating these serious birth defects. And at 5 cents a day for a generic brand multivitamin, it's one of the cheapest silver bullets around.

Because my niece was born with spina bifida, this is an issue that is very close to my heart. In North Carolina, three to four women each week get the diagnosis that their fetus's brain or spinal cord has a neural tube disorder. Many babies with brain defects die soon after birth. Those with spina bifida, however, suffer lifelong disabilities that usually involve paralysis of the lower limbs, bowel and bladder. The causes appear to be a combination of genetic, nutritional and environmental factors.

Scientists do not fully understand how folic acid works to lower the risk of neural tube defects in babies, but we do know that it is crucial for women to take folic acid for two to three months before conception and throughout pregnancy. Most people would think that, because we now understand folic acid's importance, women would automatically increase their folic acid consumption. But changing behaviors is not always easy. That's why Gov. Jim Hunt has earmarked an additional $350,000 from the state's Smart Start program to increase awareness of the benefits of folic acid.

Five years ago, the Birth Defects Center at the University of North Carolina joined with the March of Dimes and Duke University Medical Center to form the North Carolina Task Force for Prevention of Neural Tube Defects with Folic Acid. In 1995, this group held a statewide conference to inform health-care workers about the risks of birth defects and the benefits of folic acid.

The N.C. Folic Acid Council (formerly the task force) is beginning a pilot project that includes nutrition counseling for all women of childbearing age in the 17-county region with the state's highest rate of neural tube defects. Once the pilot project is under way, an intensive statewide educational program will increase awareness of the importance of folic acid, using the Smart Start money that Hunt designated.

The council also has worked to obtain grants from the March of Dimes and Centers for Disease Control and Prevention for public and professional health-care education and, since 1995, to track the incidence and causes of birth defects. This year, the General Assembly supplemented these grants with recurring funds for the monitoring program.

Identifying areas and populations where the risk is highest helps us target services and other resources such as the NTD Recurrence Prevention Program and the Folic Acid Council's education initiative. In January 1999, the CDC authorized the prevention program to provide follow-up services to women who have had a pregnancy involving spina bifida. These services include genetic counseling, help in gaining access to other resources and further education regarding the importance of folic acid use.

In addition, the Women's, Infant and Children's Program will start a new statewide folic acid educational initiative for nearly 100,000 women within a few weeks. Finally, the state will expand the Farmer's Market Nutritional Program, which will provide fresh fruits and vegetables (natural sources of folic acid) to women in the WIC program around the state beginning in spring 2001.

Taking a multivitamin daily sounds like a simple way to help prevent serious birth defects. But changing people's behavior is not a simple task. Therefore, we need to pull together private businesses, churches, health leaders and others to work on this problem, in the same manner that our state accomplishes other great objectives.

All of us can help. Tell five friends about folic acid, and ask them to tell five friends. Make sure the multivitamin you take contains folic acid. Do whatever you can to help reduce birth defects and build stronger, healthier families.

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